Ocular therapeutics

Abstract

Adherence in glaucomaCorrect use of medications has always been a problem, especially in chronic diseases. A new study using electronic monitoring of drug-bottle opening as an objective measurement of adherence in medical glaucoma management has confirmed the already widely accepted clinical impression that more complex glaucoma topical medication dosing regimens result in poorer adherence. Previously the term 'compliance' was used but 'adherence' is now considered a more appropriate term. Two populations of primary open angle glaucoma subjects were examined: those using monotherapy (once-daily prostaglandin analogues n = 31) and those requiring an adjunctive medicine to the prostaglandin analogue (two-drug group n = 31). The main outcome measures were dosing errors (number of underadherence or over-adherence events) and coverage (proportion of pharmacologic duration covered by dosing) relative to the prescribed regimen. Adherence to the prostaglandin once daily was good in both groups by all measures (less than 10 per cent of subjects with more than five dosing errors and mean coverage of 97.2 Ϯ 6.1 per cent). Adherence to the second medication in the two-drug group was poorer (37 per cent of subjects with more than five dosing errors and mean coverage of 85.6 Ϯ 12.6 per cent). For the subjects using beta-blockers, 24.8 Ϯ 18.4 per cent of doses were taken at less than 10-hour intervals (over-adherence).Robin AL, Novack GD, Covert DW, Crockett RS, Marcic TS. Adherence in glaucoma: Objective measurements of once-daily and adjunctive medication use. Am J Ophthalmol 2007; 144: 533-540. Topical insulin improves corneal healing in diabetesCorneal epithelial healing can be a significant problem among diabetic patients. A recent study using a rat model with diabetes mellitus has shown that topical application of insulin normalised delayed corneal wound healing. The method involved creating a five-millimetre corneal abrasion, which was treated topically for seven days (four times daily) with 1, 2, or 5 U of insulin or with sterile vehicle.After seven days, residual corneal epithelial defects of rats with diabetes receiving the sterile vehicle were approximately 35 per cent larger than in healthy (nondiabetic) rats receiving the sterile vehicle. Diabetic rats receiving topical insulin had wounds ranging from 19 to 60 per cent smaller than diabetic rats not receiving topical insulin, similar to wound sizes in healthy rats. Topical insulin had no effect on re-epithelialisation of corneal wounds in healthy rats, corneal thickness, intraocular pressure or serum glucose level. The corneal sensitivity of diabetic rats was markedly reduced from healthy rats but rats with diabetes given insulin had corneal sensitivity values comparable to the healthy rats. DNA synthesis in the corneal epithelium was decreased in rats with diabetes but was comparable to that in healthy rats after they received topical insulin. Apoptosis and necrosis levels were similar in all healthy rats, diabetic rats treated with insulin and untreated diabetic...